CHICAGO, Feb. 21, 2014 (GLOBE NEWSWIRE) -- Merge Healthcare Incorporated (MRGE), a leading provider of innovative enterprise imaging, interoperability and clinical systems that seek to advance healthcare, today announced that its Board of Directors has appointed William J. Devers Jr., president of Devers Group Inc, as a director, effective immediately.Italics are mine. Mr. Devers sounds like an excellent addition to the Merge team. But I'm a little intrigued by the mention of the buying and selling of software concerns. Are we announcing more than we are announcing?
"We are very fortunate to have a new director with such a considerable amount of business and software experience added to the Merge Board of Directors," said Merge Chairman Dennis Brown. "Bill's knowledge and vision will make him a significant contributor to helping Merge execute the business plan it has formulated to increase its market position in enterprise imaging and interoperability. We believe that his strategic insights and guidance will be critical as we look to increase shareholder value."
Devers was the CEO of Trans Union Credit Information Company. He left Trans Union in 1983 and started Devers Group as a vehicle for his private investments. Devers group began with an acquisition strategy, acquiring software companies in various vertical markets. Prior to divestitures, Devers Group had revenues of approximately $100 million and employed approximately 700 people.
Over the past 30 years, Mr. Devers has bought and sold over 20 software concerns, including sales to EDS, Klopotek (Berlin, Germany), DBS Systems and others. Currently, Mr. Devers manages DGI Private Equity Ventures, LLC, serves on the Board of Directors of Ryan Specialty Group, Lurie Children's Hospital of Chicago, the Big Shoulders Fund and is a less than 3% non-voting shareholder of Merrick Ventures. In addition, Mr. Devers serves on an Advisory Board at the University of Notre Dame and is a Trustee of the Museum of Science and Industry in Chicago.
One doesn’t have to work in a hospital long to experience or observe some form of disrespect. This is hardly a secret. The bullying culture of medicine has been widely written about and portrayed in popular media. In one study, published in 2012 and conducted over the course of 13 years at the David Geffen School of Medicine at the University of California, Los Angeles, more than 50 per cent of medical students across the US said they experienced some form of mistreatment. Behind closed doors, we share advice on whom to hang around and whom to avoid.Those of you reading this who are not directly part of the health-care universe might not be able to relate. But most of you will understand. The myth of the malignant surgeon throwing instruments is not all that far from the truth. These days, the flying projectiles are mostly verbal, and sometimes subtle, but they cut just as deep.
At the start of my third year of medical school, when we would finally enter the hospital wards, we had an orientation: ‘Wear a raincoat,’ the doctor standing at the podium advised. I could expect to get rained on.
Most of my friends in medicine have witnessed flagrant episodes of hospital bullying and have juicy tales to tell. But medical disrespect is usually far less dramatic, dished out in the form of ‘micro-aggressions’: exasperated sighs, a sarcastic tone, the dismissal of alternative ideas. It’s the subtle put-downs about a trainee’s competence that erode confidence; the public shaming for an incorrect answer on rounds; or the denial of simple privileges such as taking a chair or reading a chart. It’s the psychological effect of being called by your rank instead of your name, or having it made clear that your presence is a burden instead of a help. It’s being ignored. It’s other team members looking on when the disrespect occurs, afraid to challenge it and defend those lower on the totem pole. These are the acts that affect our state of mind in small but cumulative ways. This is the stuff that creates a culture.And it was bad enough in my day. I dodged a lot of it, but I felt, saw, and heard enough to confirm Ms. Yurkiewicz's observations. As a medical student, and even as a Radiology resident, I have seen the snide looks and snarky remarks flowing like sewage from the more arrogant and nasty of residents and attendings downhill to the objects of their scorn. And I've been the victim of this, often deservedly, often not.
You learn to deal. This is how it is. That’s the system. It’s ingrained. You excuse bad behaviour with the platitude: ‘That’s just the way (s)he is.’ You appreciate from your elders that it could be much worse – at least they can’t throw scalpels at you anymore.
But it is also much more dependent on the communication and relationships among different members of the team. Now, enter the culture of disrespect. Suppose an attending physician makes withering critiques or unreasonable requests. A resident, hoping to avoid such abuse, slowly but surely starts to hold back. She holds back some questions for fear of burdening and, under the constant stress of being scolded, becomes immersed in details of efficiency. Whether she intends it or not, she gives off vibes of unavailability, spending hours hunched over a computer in the physician’s conference room cranking out progress notes and scheduling patient appointments. Meanwhile, a patient starts to take a turn for the worse, but it’s not completely clear-cut – his vitals are just a bit off, his belly seems distended, and he complains of abdominal pain but is also known to the team as someone who complains. The nurse hesitates to voice her concerns to the resident, who is swamped doing paperwork and updating discharge summaries exactly the way the attending prefers. The patient continues to go downhill, and by the time word gets out the patient is much sicker – and needs to be treated far more aggressively – than would otherwise have been the case.The more you fear being caught in a mistake, the more likely you are to make more, and to cover them up. Rather than worry about harming the patient, the young skull full of mush learns to dodge bullets directed at him, and the patient be damned.
When someone is unpleasant or demeaning, something switches in the minds of those on the receiving end: they sacrifice honest communication to save face. I’ve seen it in action so many times that the pattern has become predictable. Preoccupied with fear of appearing incompetent, team members keep uncertainties under wraps.It bears repeating in large font:
The link between harsh words and medical errors was reignited in 2012 when Lucian Leape, professor of health policy at the Harvard School of Public Health, published a two-part series in Academic Medicine. ‘A substantial barrier to progress in patient safety is a dysfunctional culture rooted in widespread disrespect,’ Leape and his co-authors asserted. ‘Disrespect is a threat to patient safety because it inhibits collegiality and co-operation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices.’
It’s not that jerky personalities are reserved for those at the top. There are nice people and mean people at every rank. But in a system dependent on the proper functioning of hierarchy, it works like this: when anger and intimidation flow down, information stops flowing up. The chain of communication becomes clogged.
In a system dependent on hierarchy, it works like this: when anger and intimidation flow down, information stops flowing up.And THAT is when the mistakes propagate further and faster, and the patient is the one that suffers. Ironically, the perpetrators often realize that this is the case:
In another study by Rosenstein and O’Daniel, nurses and physicians self-reported behaving badly in near-equal numbers. Most felt this behaviour resulted in increased errors, lower quality of care, and lower patient satisfaction. Seventeen per cent could name a specific adverse event that occurred as a direct result of disrespectful behaviour.You are probably asking at this point, "WHY does this happen?" The answer, like so many in medicine, is TRADITION. For many years, interns, residents, and even medical students were kept up for days on end, struggling just to stay awake, let alone actually learn something and treat sick people. This tradition lasted for years and years, mainly because their elders did it too. Medicine, being more of an apprenticeship than anything else, can sometimes ignore facts that contradict long-held opinions:
Yet despite such (bad) outcomes, many in medicine actively protect the culture of disrespect because they hold a fundamentally flawed idea: that harshness creates competence. That fear is good for doctors-in-training and, by extension, good for patients. That public shaming holds us to higher standards. Efforts to change the current climate are shot down as medicine going ‘soft’. A medical school friend told me about a chief resident who publicly yelled at a new intern for suggesting a surgical problem could be treated with drugs. The resident then justified his tirade with: ‘Yeah, yeah, I know I was harsh. But she’s gotta learn.’Bottom line, this crap kills. And it needs to change.
We can no longer deny the facts. Bad cultures lead to bad outcomes. Jerks do not make good medicine. They foster a backwards atmosphere that degrades trust, tarnishes open communication, and promotes cover-ups.There are solutions out there, mainly dealing with individual, solitary incidents. But how do you change a culture?
Creating a culture of respect is not just about feeling good, for its own sake. It’s better for patient care.
...(W)e should put an end to the premium that the medical establishment places on saving face. This is a hazard. It feeds the egotistical environment that can lead to ignoring input and failing to ask for help. It creates doctors who value looking like they know what they’re doing at all times more than actually doing what is best.The suffering we see among our patients overshadows our personal pain, but...
(W)e should be getting to the root of the behaviour. Why do people behave badly? Some are just jerks. Some imitate jerks. But we also can’t ignore a system that takes loads of formerly ‘nice’ people and churns out jaded, bitter, and gruff ones. We have to call attention to the external factors that can contribute. The lack of sleep. The poor hours. The system that overbooks and overworks.
Environments such as these persist in part because of our unique vantage point in taking care of others at some of the worst points in their lives. How can I say ‘I’m tired’ or ‘I’m hungry’ or ‘He hurt my feelings’ in the face of such profound human suffering? Yet it’s hardly absurd to ask for better working conditions. When working in a system that treats us all humanely, we’re more likely to be humane to each other, and to our patients.I'm not the world's best radiologist, although I think I hold my own. This will sound like whining, and it is, but I truly think I would have been a better physician, and a better radiologist, had the culture been different. Had my many mistakes (and we've all made them in this business) been used more as teaching opportunities, and less as excuses for public humiliation, I think I would have learned more from them. To be honest, the majority of my mentors in medical school and residency were indeed wonderful teachers, with the gift of making you happy you had made the mistake they were correcting. But I had a few, and they tended to be the BIG NAMES in the field, who would take off after any answer and any action that was less than perfect. As one of the more mediocre trainees, I got a lot of that from these people.
Instead of looking away sheepishly when our colleagues are mistreated and apologising for bad behaviour with tired mantras, we should push back. Bullies have ripple effects. Medical students mimic the behaviour of residents who mimic the behaviour of attendings until a problem with attitude can extend from a few people to an entrenched culture. Instead of riding that wave, we could shun bad behaviour. This is easier said than done. But cultures change because people within commit to changing them; it won't come by decrees. A culture that shames bullying makes the bully look like the bad guy, rather than making the recipient look weak.Of course, I'll be long-retired before we see this sort of sea-change in medical culture. But it is reassuring to know that it might be coming after all.
Dalai's note: As my earlier post was prompted in large part by my friend Brad Levin's discussions of PACS deficiencies, I gave him a heads up upon its publication. Brad zeroed in on this snide comment..."As an aside, some have suggested that IT-savvy departments assemble their own PACS from off-the-shelf components. To that, I can only say, "BWWWWAAAAAHAHAHAHAHA!" Good luck, folks. Not going to happen for the foreseeable future, at least not in my enterprise.” He wrote the following response which is most worthy of your attention. Without further ado, heeeeerrrrrrreeeee's Brad!
Last Spring, after attending an Institute of Medicine meeting on Childhood Obesity, I wrote about fronts and Heroes in the Health Attention War. Arguing that if we were going to do anything about long-term patient engagement around health and influencing healthy decisions, we had to start with habits and getting attention at an early age. Attention is the first step towards long-term behavior change.
At that time, I was happy to see the The Ad Council, who has been so successful in campaigns around littering and drunk driving, was working to get attention around childhood obesity to some specific communities. Advertising, after all, is all about directing attention, the necessary first step towards new behavior change. Meanwhile, some school districts were using the ideas behind behavioral economics to influence healthy food choices in schools, which continue to show success.
Today, I’m happy to report that something – or many things – have been working. Via the Robert Wood Johnson Foundation (RWJF) a JAMA Report “shows that that obesity prevalence among 2 to 5 year olds has dropped by approximately 40 percent in eight years.” This is truly outstanding progress. This is the most important age group to address as habits formed here can remain very hard to break later in life.
RWJF goes on to say “After decades of seemingly endless bad news about obesity, our collective efforts over the last several years show that we as a nation are finally moving in the right direction. Of course we can’t stop now.”
Also encouraging, they mention a report yesterday by “Let’s Move” declaring , “Nine out of ten schools across the country are certified to meet healthier lunch standards, and all schools with 40 percent of students qualifying for free or reduced-price lunch will soon be able to provide healthier, free meals to all of their students.”
Let’s continue to build on this progress, getting attention and enabling smarter choices around the problem that eventually became our nation’s health care crisis.
“Healthcare is influenced by where people live, learn, work and play, which has a huge influence on an individual’s overall health.” ~ Karen DeSalvo, MD, MPH, MSc
This year’s HIMSS Annual Conference and Exhibition saw Karen DeSalvo, the new National Coordinator for Health Information Technology, take the stage and it was clear we are entering a new era under her leadership. She recognizes that we are at a pivot point in the history of health IT and sees the need for everyone to take a breath and possibly find some better ways to reach some of our goals.
Speaking at a press event on Tuesday, one on one with me on Wednesday (video is below), during a Town Hall as well as a CCHIT led forum, then during her keynote on Thursday with CMS Administrator Marilyn Tavenner, and finally another press availability at the end of the conference, she laid out a broad vision of the current landscape and where we are heading as an industry.
On Tuesday DeSalvo explained some of her goals. One would be that every provider is using an EHR and health IT to capture, share and meaningfully use health information.
“That requires that there’s some floor that we set, that is raised, whether you’re a rural, small hospital, provider, payer, whatever you are,” she said. She also iterated a policy goal of using meaningful use as a driver to advance the healthcare marketplace. “It’s one thing to have an EHR,” she said. “We need to meaningfully use it, and push technology so that it is driving interoperability across the continuum and that it is improving outcomes.”
She also spoke of the critical importance of interoperability. “The reason I get excited about interoperability is because for it to work, for the doctor to show up in the ER and to know what medicine you’re allergic to, if you’re unconscious and need some help, there’s a lot of back work to see that everything comes together just at the right moment to save your life. That’s pretty exciting to me,” she said.
On Wednesday she joined former National Coordinators for a very interesting discussion on the birth and growth of the ONC. The only one missing was Dr. David Blumenthal, who headed the ONC during the passage of the HITECH Act and was instrumental in its creation.
“I’m sorry David Blumenthal isn’t here because he was advising (the Obama administration) but he was also advising Kerry when he ran against Bush,” said David Brailer, the first National Coordinator. “We spent the entire night trying to get two teams to back off of each other. We both agreed the next morning we made health IT bipartisan.”
The bipartisan nature of health IT was also important to Rob Kolodner during his tenure at ONC. “We didn’t want anyone to grab and control the core infrastructure. It was important to bring it in the room so that the solution didn’t favor one interest or the other.”
But Washington, DC, is often gridlocked, and even bipartisan efforts are difficult to get into law. It was only during a financial crisis and the trillion dollar stimulus that could really provide the funding to substantially move the needle on health IT adoption.
“It took an economic crash to create the opening for something that the groundwork had been laid for,” former National Coordinator Farzad Mostashari said. “The idea that we would get this opportunity was so unbelievable, literally unbelievable, and when the HITECH Act passed, it was a broad movement.”
Dr. DeSalvo, with only weeks in her current role, said, “I don’t have a low point yet.” She expressed optimism about her work saying that after her first HIT Policy meeting, “I got very excited about that because this is a community of vendors, purchases, providers, policy folks, who really want to get it right.”
The ONC has been focusing heavily on patient ID matching recently, including launching a collaborative initiative last fall.
During her keynote Thursday she emphasized interoperability and health data exchange saying, “We can do national healthcare exchange in three years.”
She also stressed the importance of meeting the challenge of patient matching to be sure that the right information about the right patient is being shared safely and securely. “This issue of patient matching and making sure that we get that right is very important,” she said. But she was very optimistic that we can get this done. “I know that this is possible. I have seen exchange in every part of our country.”
With regards to flexibility in stage 2 meaningful use and the challenges of many providers to meet the requirements in 2014, CMS Administrator Marilyn Tavenner announced that CMS will be “flexible” in granting providers “hardship exemptions on a case-by-case basis.”
“We have decided to permit flexibility in how hardship exemptions are granted in the 2014 reporting year,” Tavenner said.
Last December they announced they were extending Stage 2 of the HITECH Act EHR incentive program one year but that did not give any relief with providers who are struggling to meet the requirements in 2014, while simultaneously dealing with the ICD-10 conversion and a plethora of government mandates. Possible exemptions will be outlined in a forthcoming FAQ and will likely include vendors not being ready with their stage 2 technology.
The exemptions to deadlines will be granted for providers in situations where, “despite their best efforts, for reasons beyond their control, they can’t meet meaningful use Stage 2.” I predict there will be a LOT of providers that will need to take advantage of these hardship exemptions in order to avoid penalties.
Standing firm on the upcoming ICD-10 deadline, Tavenner said, “Now is not the time for us to start moving forward. Let’s face it, we’ve delayed this several times, and it’s time to move on.”
The switch from ICD-9 to ICD-10 means that the industry will have to change from about 14,000 codes to about 69,000 codes. I think the deadline for implementing the ICD-10 diagnostic coding set of October 1, 2014. is fairly well carved in stone. Since it had already been delayed one year, now it will not be delayed again.
At the press conference following the keynote, Dr. DeSalvo reiterated the hardship exemptions. Recognizing the call by a coalition of provider organizations to delay the timeline of the meaningful use incentive program and to offer providers more flexibility, she offered hope that these exemptions might stave off failure.
During my discussion with Dr. DeSalvo at HIMSS, she did a very good job of extemporaneously laying out the current landscape of health IT and a glimpse of the future. One of the things that I found compelling was the notion that we could eventually begin to pull in all those data that are outside of the traditional healthcare system that make up what are termed the “social determinants of health.”
She talked about the quantified self movement, patient-generated health information, and a move away from capturing data in the standard EHR to include all of these other data—including providers, patients, payers, and the entire healthcare ecosystem in the digital architecture. She paints an interesting picture of a future tech-enabled transformed health system.
Happy HIMSS to one and all! I say this because this week is HIMSS’ annual conference and exhibition, HIMSS14. The annual event is much like Christmas. People spend months preparing and looking forward to the big day, in this case big week. And when it gets here it’s a whirlwind of excitement over meeting up old friends, discovering new things and seeing some renowned and famous people. At Christmas it’s Santa. At HIMSS14 its Hilary Rodham Clinton. Also, like Christmas the week after the HIMSS conference is spent recouping from the excitement of the big event.
To get the most out of HIMSS14 (and Christmas) it’s a good idea to make a list and check it twice. Between the speakers, special sessions and exhibitors, there is a ton of information to be had at HIMSS14 and at times it can get overwhelming. In fact, just a few weeks ago Shane Damico wrote a post for HL7standards.com full of advice on how to make the most of HIMSS14 that I hope everyone read before attending.
What I’d like to do is to get feedback from HIMSS14 conference attendees on a few of the sessions I’ve listed below. You came, you saw, you conquered and now what do you plan to do with your new knowledge? How will you apply this information to nursing? What do you think it means for the nursing profession as a whole? So please comment here or tweet your musings to @healthstandards #HIMSS14. We want to know what you’re discovering!
Nursing Informatics Hot Topics Review
This interactive panel session was held Feb. 22 and covered up-and-coming innovations in the field of nursing informatics with a focus on quality. The goal of the session was to:
So what did those of you who attended learn? How will health IT facility quality measurement and improvement?
I think systems that allow nurses to collect and compare data and outcomes will have a huge effect on the type of care we provide. It’s real time evidence-based practice. I feel that in the past, we nurses have sometimes felt obligated to launch a quality improvement project and we run to the literature first to see what others have done. But by first analyzing your own data you can determine what you really need to work on at your facility. The numbers can help guide you as to what to improve so you can then focus on literature that will help solve your problem and present possible interventions.
What did you find most valuable about this session?
This session explores implementation of new care delivery models, how the profession must enable tomorrow’s leaders and the value of informatics principles in this transformation from a nurse executive’s perspective. Session objectives were to:
What are specific opportunities to show leadership at the executive level? From my perspective, because IT can be a process driver, it’s a chance to work with other nurse leaders and executives to develop and nurture new and efficient patient care workflows. It’s also an opportunity to make the bedside nurses’ jobs more efficient by developing a process and selecting a product to allow them to spend more time with the patient at the bedside.
What was your biggest a-ha! moment during this seminar?
This session was Feb. 26 and part of the TIGER Institute. It features a presentation of findings from two health IT patient engagement studies. The first study measured the impact of patient engagement tools (kiosks, portals, and mobile phones) on decision-making, adherence to care plans, and healthcare outcomes. The second study discusses the development and roll-out of a patient engagement portal to support interdisciplinary care teams in engaging patients.
Goals of the session are:
I’ve written about patient engagement recently in regards to OpenNotes and patient assertiveness so I’m interested to hear what you have learned during this session regarding patient engagement. What types of data show that more engaged patients help reduce costs? How can you get patients interested in and using portals and how does it benefit the clinicians?
The title of this poster presentation caught my eye because of the word Technostress. I was glad to see someone acknowledge that technology is often a source of stress among nurses. It’s a legitimate thing, not just nurses whining.
As the poster’s description says: “Nurses represent one population that has been pressured to utilize the EHR, has suffered stress during the process, and has been forced to adapt to the challenges inherent with multiple changes in workflow, often without any feedback into the activities that directly affected them. This research examined the effect of technostress creators and inhibitors on the perceived productivity of nurses.”
The objectives of the poster presentation:
I would love to hear some of the strategies visitors came away with and attend to apply back at their facilities. And does reducing technostress improve nurses use of EHR? Tell us what you think!
If you attended a session that isn’t on this list please share your experience with us here or at @HealthStandards #HIMSS14, or with me directly @Jen_NurseEditor.
I hope you enjoyed this year’s event and remember HIMSS15 is only 365 days away in my hometown of Chicago!
Healthcare executives are continuously evaluating the subject of RFID and RTLS in general. Whether it is to maintain the hospitals competitive advantage, accomplish a differentiation in the market, improve compliance with requirements of (AORN, JCAHO, CDC) or improve asset utilization and operating efficiency. As part of the evaluations there is that constant concern around a tangible and measurable ROI for these solutions that can come at a significant price.
When considering the areas that RTLS can affect within the hospital facilities as well as other patient care units, there are at least four significant points to highlight:
Disease surveillance: With hospitals dealing with different challenges around disease management and how to handle it. RTLS technology can determine each and every staff member who could have potentially been in contact with a patient classified as highly contagious or with a specific condition.
Hand hygiene compliance: Many health systems are reporting hand hygiene compliance as part of safety and quality initiatives. Some use “look-out” staff to walk the halls and record all hand hygiene actives. However, with the introduction of RTLS hand hygiene protocol and compliance when clinical staff enter or use the dispensers can now be dynamically tracked and reported on. Currently several of the systems that are available today are also providing active alters to the clinicians whenever they enter a patient’s room and haven’t complied with the hand hygiene guidelines.
Locating equipment for maintenance and cleaning:
Having the ability to identify the location of equipment that is due for routine maintenance or cleaning is critical to ensuring the safety of patients. RTLS is capable of providing alerts on equipment to staff.
A recent case of a hospital spent two months on a benchmarking analysis and found that it took on average 22 minutes to find an infusion pump. After the implementation of RTLS, it took an average of two minutes to find a pump. This cuts down on lag time in care and can help ensure that clinicians can have the tools and equipment they need, when the patient needs it.
There are also other technologies and products which have been introduced and integrated into some of the current RTLS systems available.
There are several RTLS systems that are integrated with Bed management systems as well as EHR products that are able to deliver patient order status, alerts within the application can also be given. This has enabled nurses to take advantage of being in one screen and seeing a summary of updated patient related information.
Unified Communication systems:
Nurse calling systems have enabled nurses to communicate anywhere the device is implemented within the hospital facility, and to do so efficiently. These functionalities are starting to infiltrate the RTLS market and for some of the Unified Communication firms, it means that their structures can now provide a backbone for system integrators to simply integrate their functionality within their products.
In many of the recent implementations of RTLS products, hospital executives opted to deploy the solutions within one specific area to pilot the solutions. Many of these smaller implementations succeed and allow the decision makers to evaluate and measure the impacts these solutions can have on their environment. There are several steps that need to be taken into consideration when implementing asset tracking systems:
• Define the overall goals and driving forces behind the initiative
• Develop challenges and opportunities the RTLS solution will be able to provide
• Identify the operational area that would yield to the highest impact with RTLS
• Identify infrastructure requirements and technology of choice (WiFi based, RFID based, UC integration, interface capability requirements)
• Define overall organizational risks associated with these solutions
• Identify compliance requirements around standards of use
RFID is one facet of sensory data that is being considered by many health executives. It is providing strong ROI for many of the adapters applying it to improve care and increase efficiency of equipment usage, as well as equipment maintenance and workflow improvement. While there are several different hardware options to choose from, and technologies ranging from Wi-Fi to IR/RF, this technology has been showing real value and savings that health care IT and supply chain executives alike can’t ignore.
It was not long after mankind invented the wheel, carts came around. Throughout history people have been mounting wheels on boxes, now we have everything from golf carts, shopping carts, hand carts and my personal favorite, hotdog carts. So you might ask yourself, “What is so smart about a medical cart?”
Today’s medical carts have evolved to be more than just a storage box with wheels. Rubbermaid Medical Solutions, one of the largest manufacturers of medical carts, have created a cart that is specially designed to house computers, telemedicine, medical supply goods and to also offer medication dispensing. Currently the computers on the medical carts are used to provide access to CPOE, eMAR, and EHR applications.
With the technology trend of mobility quickly on the rise in healthcare, organizations might question the future viability of medical carts. However a recent HIMSS study showed that cart use, at the point of care, was on the rise from 26 percent in 2008 to 45 percent in 2011. The need for medical carts will continue to grow; as a result, cart manufacturers are looking for innovative ways to separate themselves from their competition. Medical carts are evolving from healthcare products to healthcare solutions. Instead of selling medical carts with web cameras, carts manufacturers are developing complete telemedicine solutions that offer remote appointments throughout the country, allowing specialist to broaden their availability with patients in need. Carts are even interfaced with eMAR systems that are able to increase patient safety; the evolution of the cart is rapidly changing the daily functions of the medical field.
Some of the capabilities for medical carts of the future will be to automatically detect their location within a healthcare facility. For example if a cart is improperly stored in a hallway for an extended period of time staff could be notified to relocate it in order to comply to the Joint Commission’s requirements. Real-time location information for the carts could allow them to automatically process tedious tasks commonly performed by healthcare staff. When a cart is rolled into a patient room it could automatically open the patient’s electronic chart or give a patient visit summary through signals exchanged between then entering cart and the logging device kept in the room and effectively updated.
Autonomous robots are now starting to be used in larger hospitals such as the TUG developed by Aethon. These robots increase efficiency and optimize staff time by allowing staff to focus on more mission critical items. Medical carts in the near future will become smart robotic devices able to automatically relocate themselves to where they are needed. This could be used for scheduled telemedicine visits, the next patient in the rounding queue or for automated medication dispensing to patients.
Innovation will continue in medical carts as the need for mobile workspaces increase. What was once considered a computer in a stick could be the groundwork for care automation in the future.
This has been an eventful year for speech recognition companies. We are seeing an increased development of intelligence systems that can interact via voice. Siri was simply a re-introduction of digital assistants into the consumer market and since then, other mobile platforms have implemented similar capabilities.
In hospitals and physician’s practices the use of voice recognition products tend to be around the traditional speech-to-text dictation for SOAP (subjective, objective, assessment, plan) notes, and some basic voice commands to interact with EHR systems. While there are several new initiatives that will involve speech recognition, natural language understanding and decision support tools are becoming the focus of many technology firms. These changes will begin a new era for speech engine companies in the health care market.
While there is clearly tremendous value in using voice solutions to assist during the capture of medical information, there are several other uses that health care organizations can benefit from. Consider a recent product by Nuance called “NINA”, short for Nuance Interactive Natural Assistant. This product consists of speech recognition technologies that are combined with voice biometrics and natural language processing (NLP) that helps the system understand the intent of its users and deliver what is being asked of them.
This app can provide a new way to access health care services without the complexity that comes with cumbersome phone trees, and website mazes. From a patient’s perspective, the use of these virtual assistants means improved patient satisfaction, as well as quick and easy access to important information.
Two areas we can see immediate value in are:
Customer service: Simpler is always better, and with NINA powered Apps, or Siri like products, patients can easily find what they are looking for. Whether a patient is calling a payer to see if a procedure is covered under their plan, or contacting the hospital to inquire for information about the closest pediatric urgent care. These tools will provide a quick way to get access to the right information without having to navigate complex menus.
Accounting and PHR interaction: To truly see the potential of success for these solutions, we can consider some of the currently used cases that NUANCE has been exhibiting. In looking at it from a health care perspective, patients would have the ability to simply ask to schedule a visit without having to call. A patient also has the ability to call to refill their medication.
Nuance did address some of the security concerns by providing tools such as VocalPassword that will tackle authentication. This would help verify the identity of patients who are requesting services and giving commands. As more intelligence voice-driven systems mature, the areas to focus on will be operational costs, customer satisfaction, and data capture.
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This year I’m chairing a healthcare IT event series called HealthIMPACT — it’s what I’m hoping will be some of the best places for healthcare technology enthusiasts and buyers to get actionable advice on what’s real, what’s BS, what to buy, what not to buy, and perhaps most importantly, which guidance is worth following. In order to make sure we cover the right topics, we have created a very short survey so that we have some evidence-driven approaches to proving we’re focusing on the right areas.
The survey should only take a couple of minutes to take and includes the following questions:
If you have a few minutes, please take the survey and help us make sure that these events are as filled with actionable advice as possible.
John Lynn, prolific blogger and health IT media magnate, and I are teaming up to produce and deliver the world’s first marketing conference focused on helping innovators cut through the noise when trying to market their healthcare and medical tech products to physicians, hospitals, and similar customers. Called The Healthcare IT Marketing Conference, it will cover very important subjects by some of the world’s best experts on those topics.
Learn how to align the Payers, Beneficiaries, and Users (PBU) of your Health IT or MedTech product
There are three distinct groups you’re marketing and selling your products to:
I call this the “PBU alignment” problem. In a complex environment like healthcare, the three groups are often not the same — if you can find a market in which the payers, the beneficiaries, and the users are all the same then your sales job is easy. However, that’s commonly not the case. Let’s take a look at the typical example of a complex product like an electronic medical records (EMR) software package in the era of ARRA, HITECH, and meaningful use (MU). The “payer” may ultimately be government reimbursements through Medicare, the “beneficiaries” are the healthcare insurance firms and the government agencies that need the MU data, and the “users” are the doctors and staff at physicians offices and hospitals. Why has it taken decades for EMRs to be sold to just a tiny fraction of the total industry? Because the PBU alignment hasn’t been reached — until the users, beneficiaries, and payers of the products all understand the value and are willing to work together to achieve a goal it will be tough.
Join us at the conference to talk with experts on the PBU lesson and advice for your product. Figure out the PBU alignment problem and see how you’ll sell to each of the groups and make the right arguments — you do it right and you’ll make money. If you forget the complexities of the PBU and you’ll be languishing, too.
Learn the difference between Marketing, Advertising, PR, and Branding
Everyone tells small companies that they need to “do marketing” but that’s really hard to do so I started with a quick visual to explain what it means. It comes from Marty Neumeier on pages 24 and 25 of ZAG by way of the Brand Autopsy Blog (which I highly recommend reading) and illustrates the differences between Marketing, Advertising, PR, and Branding. It’s a wonderful visual and clearly shows that small companies should focus on marketing and free PR, shoot for branding and probably eschew advertising until they have enough money. Our expert speakers know the difference and can teach you how to make sure you’re not taking the wrong steps.
Learn about major healthcare industry fallacies
Selling to the healthcare community is very hard and there are many myths that our conference will dispel:
Learn how to conduct appropriate market research
Lots of (even innovative) companies don’t do basic market research so we will cover:
Learn about the different kinds of of Business Models to consider
Go home with many tips and tricks:
I’ll be leaving for HIMSS’14 on Saturday and plan to be around for meetings and sessions from Sunday through Wednesday. Here are some of the places I plan to be, catch me if you’re around:
“Large collections of electronic patient records have long provided abundant, but under-explored information on the real-world use of medicines. But when used properly these records can provide longitudinal observational data which is perfect for data mining,” Duan said. “Although such records are maintained for patient administration, they could provide a broad range of clinical information for data analysis. A growing interest has been drug safety.”
In this paper, the researchers proposed two novel algorithms—a likelihood ratio model and a Bayesian network model—for adverse drug effect discovery. Although the performance of these two algorithms is comparable to the state-of-the-art algorithm, Bayesian confidence propagation neural network, by combining three works, the researchers say one can get better, more diverse results.
I saw this a few weeks ago, and while I haven't had the time to delve deep into the details of this particular advance, it did at least give me more reason for hope with respect to the big picture of which it is a part.
It brought to mind the controversy over Vioxx starting a dozen or so years ago, documented in a 2004 article in the Cleveland Clinic Journal of Medicine. Vioxx, released in 1999, was a godsend to patients suffering from rheumatoid arthritic pain, but a longitudinal study published in 2000 unexpectedly showed a higher incidence of myocardial infarctions among Vioxx users compared with the former standard-of-care drug, naproxen. Merck, the patent holder, responded that the difference was due to a "protective effect" it attributed to naproxen rather than a causative adverse effect of Vioxx.
One of the sources of empirical evidence that eventually discredited Merck's defense of Vioxx's safety was a pioneering data mining epidemiological study conducted by Graham et al. using the live electronic medical records of 1.4 million Kaiser Permanente of California patients. Their findings were presented first in a poster in 2004 and then in the Lancet in 2005. Two or three other contemporaneous epidemiological studies of smaller non-overlapping populations showed similar results. A rigorous 18-month prospective study of the efficacy of Vioxx's generic form in relieving colon polyps showed an "unanticipated" significant increase in heart attacks among study participants.
Merck's withdrawal of Vioxx was an early victory for Big Data, though it did not win the battle alone. What the controversy did do was demonstrate the power of data mining in live electronic medical records. Graham and his colleagues were able to retrospectively construct what was effectively a clinical trial based on over 2 million patient-years of data. The fact that EMR records are not as rigorously accurate as clinical trial data capture was rendered moot by the huge volume of data analyzed.
Today, the value of Big Data in epidemiology is unquestioned, and the current focus is on developing better analytics and in parallel addressing concerns about patient privacy. The HITECH Act and Obamacare are increasing the rate of electronic biomedical data capture, and improving the utility of such data by requiring the adoption of standardized data structures and controlled vocabularies.
We are witnessing the dawning of an era, and hopefully the start of the transformation of our broken healthcare system into a learning organization.
I believe if we reduce the time between intention and action, it causes a major change in what you can do, period. When you actually get it down to two seconds, it’s a different way of thinking, and that’s powerful. And so I believe, and this is what a lot of people believe in academia right now, that these on-body devices are really the next revolution in computing.
I am convinced that wearable devices, in particular heads-up devices of which Google Glass is an example, will be playing a major role in medical practice in the not-too-distant future. The above quote from Thad Starner describes the leverage point such devices will exploit: the gap that now exists between deciding to make use of a device and being able to carry out the intended action.
Right now it takes me between 15 and 30 seconds to get my iPhone out and do something useful with it. Even in its current primitive form, Google Glass can do at least some of the most common tasks for which I get out my iPhone in under five seconds, such as taking a snapshot or doing a Web search.
Closing the gap between intention and action will open up potential computing modalities that do not currently exist, entirely novel use case scenarios that are difficult even to envision before a critical mass of early adopter experience is achieved.
The Technology Review interview from which I extracted the quote raises some of the potential issues wearable tech needs to address, but the value proposition driving adoption will soon be truly compelling.
I'm adding some drill-down links below.
Practices tended to use few formal mechanisms, such as formal care teams and designated care or case managers, but there was considerable evidence of use of informal team-based care and care coordination nonetheless. It appears that many of these practices achieved the spirit, if not the letter, of the law in terms of key dimensions of PCMH.
One bit of good news about the Patient Centered Medical Home (PCMH) model: here is a study showing that in spite of considerable challenges to PCMH implementation, the transformations it embodies can be and are being implemented even in small primary care practices serving disadvantaged populations.
In the future it is hoped that the use of communities of practice in nursing will grow beyond knowledge sharing and promote more knowledge discovery and sense making. p.189.I’m not sure if e-portfolios have affected the EU populace with the rapidity and extent expected (by 2010), but there is a series of ongoing conferences dedicated to the cause. In the 1990s and early 2000s you could not miss the emphasis on benefits realization. If this concept has had its day what exactly happened? (There is no longer a need to prove the worth, potential of the computer at the bedside, nurses station.) We should still focus on outcomes as noted in several chapters.
Twitter, like the Internet in general, has become a vast source of and resource for health care information. As with other tools on the Internet it also has the potential for misinformation to be distributed. In some cases this is done by accident by those with the best intentions. In other cases it is done on purpose such as when companies promote their products or services while using false accounts they created.
In order to help determine the credibility of tweets containing health-related content I suggest the using the following checklist (adapted from Rains & Karmikel, 2009):
Ultimately it is up to the individual to determine how to use health information they find on Twitter or other Internet sources. For patients anecdotal or experiential information shared by others with the same illness may be considered very credible. Others conducting research may find this a less valuable information source. Conversely a researcher may only be looking for tweets that contain reference to peer-reviewed journal articles whereas patients and their caregivers may have little or no interest in this type of resource.
Rains, S. A., & Karmike, C. D. (2009). Health information-seeking and perceptions of website credibility: Examining Web-use orientation, message characteristics, and structural features of websites. Computers in Human Behavior, 25(2), 544-553.
The altmetric movement is intended to develop new measures of production and contribution in academia. The following article provides a primer for research scholars on what metrics they should consider collecting when participating in various forms of social media.
If you participate on Twitter you should be keeping track of the number of tweets you send, how many times your tweets are replied to, re-tweeted by other users and how many @mentions (tweets that include your Twitter handle) you obtain. ThinkUp is an open source application that allows you to track these metrics as well as other social media tools such as Facebook and Google +. Please read my extensive review about this tool. This service is free.
You should register with a domain shortening service such as bit.ly, which will provide you with an API key that you can enter into applications you use to share links. This will provide a means to keep track of your click-through statistics in one location. Bit.ly records how many times a link you created was clicked on, the referrer and location of the user. Consider registering your own domain name and using it to shorten your tweets as a means of branding. In addition, you can use your custom link on electronic copies of your CV or at your own web site. This will inform you when your links have been clicked on. You should also consider using bit.ly to create links used at your web site, providing you with feedback on which are used the most often. For example, all of the links in this article were created using my custom bit.ly domain. In addition, you can tweet a link to any research study you publish to publicize as well as keep track of how many clicks are obtained. Bit.ly is a free service.
Another tool to measure your tweets is TweetReach. This service allows you to track the reach of your tweets by Twitter handle or tweet. It provides output in formats that can be saved for use elsewhere (Excel, PDF or the option to print or save your output by link). To use these latter features you must sign up for an account but the service is free.
Buffer is a tool that allows you to schedule your tweets in advance. You can also connect Buffer to your bit.ly account so links used can be included in your overall analytics. Although Buffer provides its own measures on click-through counts this can contradict what appears in bit.ly. This service is free but also has paid upgrade options available that provide more detailed analytics.
Google Scholar Citation Profile
You can set up a profile with Google Scholar based on your publication record. The metrics provided by this service include a citation count, h-index and i10-index. When someone searches your name using Google Scholar your profile will appear at the top before any of the citations. This provides a quick way to separate your articles from someone else who has the same name as you.
Google Feedburner for RSS feeds
If you maintain your own web site and use RSS feeds to announce new postings you can also collect statistics on how many times your article is clicked on. Feedburner, recently acquired by Google provides one way to measure this. You enter your RSS feed ULR and a report is generate, which can be saved in CVS format.
Journal article download statistics
Many journals provide statistics on the number of downloads of articles. Keep track of those associated with your publication by visiting the site. For example, BioMed Central (BMC) maintains an access count of the last 30 days, one year and all time for each of your publications.
Other means of contributing to the knowledge base in your field include participating on web-based forums or web sites such as Quora. Quora provides threaded discussions on topics and allows participants to both generate and respond to the question. Other users vote on your responses and points are accrued. If you want another user to answer your question you must “spend” some of your points. Providing a link to your public profile on Quora on your CV will demonstrate another form of contribution to your field.
Paper.li is a free service that curates content and renders it in a web-based format. The focus of my Paper.li is the use of technology in Canadian Healthcare. I have also created a page that appears at my web site. Metrics on the number of times your paper has been shared via Facebook, Twitter, Google + and Linked are available. This service is free.
Twylah is similar to paper.li in that it takes content and displays it in a newspaper format except it uses your Twitter feed. There is an option to create a personalized page. I use tweets.lauraogrady.ca. I also have a Twylah widget at my web site that shows my trending tweets in a condensed magazine layout. It appears in the side bar. This free service does not yet provide metrics but can help increase your tweet reach. If you create a custom link for your Twylah page you can keep track of how many people visit it.
Analytics for your web site
Log file analysis
If you maintain your own web site you can use a variety of tools to capture and analyze its use. One of the most popular applications is Google Analytics. If you are using a content management system such as WordPress there are many plug-ins that will add the code to the pages at your site and produce reports. WordPress also provides a built-in analytic available through its dashboard.
If you have access to the raw log files you could use a shareware log file program or the open source tool Piwik. These tools will provide summaries about what pages of your site are visited most frequently, what countries the visitors come from, how long visitors remain at your site and what search terms are used to reach your site.
All of this information should be included in the annual report you prepare for your department and your tenure application. This will increase awareness of altmetrics and improve our ability to have these efforts “count” as contributions in your field.